Healthcare Provider Details

I. General information

NPI: 1174864896
Provider Name (Legal Business Name): PEGGY A MCGINTY DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N EAST ST
PONCA NE
68770-7259
US

IV. Provider business mailing address

PO BOX 658
PONCA NE
68770-0658
US

V. Phone/Fax

Practice location:
  • Phone: 402-755-2291
  • Fax: 402-755-2292
Mailing address:
  • Phone: 402-755-2291
  • Fax: 402-755-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. PEGGY A. MCGINTY
Title or Position: OWNER
Credential: DDS
Phone: 402-755-2291